Psychiatric Mental Health Nursing by Videbeck

52 Unit 1 CURRENTTHEORIES ANDPRACTICE

Table 3-1

(Continued)

Sublimation

Substitution

Suppression

Undoing

Substituting a socially acceptable activity for an impulse that is unacceptable

• Person who has quit smoking sucks on hard candy when the urge to smoke arises.


• Person goes for a 15-minute walk when tempted to eat junk food.
  Replacing the desired gratification with one that is more readily available


• Woman who would like to have her own children opens a day care center.
  Conscious exclusion of unacceptable thoughts and feelings from conscious awareness


• A student decides not to think about a parent’s illness in order to study for a test.


• A woman tells a friend she cannot think about her son’s death right now.
  Exhibiting acceptable behavior to make up for or negate unacceptable behavior


• A person who cheats on a spouse brings the spouse a bouquet of roses.


• A man who is ruthless in business donates large amounts of money to charity.

Table 3-2

FREUD’SDEVELOPMENTALSTAGES

Phase Age Focus

Oral

Anal

Phallic/oedipal

Latency

Genital

Major site of tension and gratification is the mouth, lips, and tongue;

includes biting and sucking activities.

Id present at birth

Ego develops gradually from rudimentary structure present at birth.

Anus and surrounding area are major source of interest.

Acquisition of voluntary sphincter control (toilet training)

Genital focus of interest, stimulation, and excitement

Penis is organ of interest for both sexes.

Masturbation is common.

Penis envy (wish to possess penis) seen in girls; oedipal complex (wish

to marry opposite-sex parent and be rid of same-sex parent) seen in

boys and girls

Resolution of oedipal complex

Sexual drive channeled into socially appropriate activities such as

school work and sports

Formation of the superego

Final stage of psychosexual development

Begins with puberty and the biologic capacity for orgasm; involves the

capacity for true intimacy

Birth to 18 months

18–36 months

3–5 years

5–11 or 13 years

11–13 years

Adapted from Gabbard, G. O. (2000). Theories of personality and psychopathology: Psychoanalysis. In B. J.
Sadock & V. A. Sadock (Eds.). Comprehensive textbook of psychiatry,Vol. 2 (7th ed., pp. 563–607). Philadel-
phia, Lippincott Williams & Wilkins.

are automatic and unconscious in the therapeutic re-
lationship. For example, an adolescent female client
working with a nurse who is about the same age as
the teen’s parents might react to the nurse like she
reacts to her parents. She might experience intense
feelings of rebellion or make sarcastic remarks; these
reactions are actually based on her experiences with
her parents, not the nurse.
Countertransferenceoccurs when the thera-
pist displaces onto the client attitudes or feelings from
his or her past. For example, a female nurse who has
teenage children and who is experiencing extreme
frustration with an adolescent client may respond by

adopting a parental or chastising tone. The nurse is

countertransfering her own attitudes and feelings

toward her children onto the client. Nurses can deal

with countertransference by examining their own feel-

ings and responses, using self-awareness, and talking

with colleagues.

CURRENT PSYCHOANALYTIC PRACTICE

Psychoanalysisfocuses on discovering the causes of

the client’s unconscious and repressed thoughts, feel-

ings, and conflicts believed to cause anxiety and help-

ing the client to gain insight into and resolve these